The Salmonella group contains many members, most of which cause diarrhoeal diseases. They are aerobic, Gram-negative rods which are not normally present as commensals in the gut.

Typhoid and paratyphoid are caused by Salmonella typhi and Salmonella paratyphi (types A, B & C) respectively. They are often termed enteric fevers, producing systemic symptoms such as headache, fever, arthralgia.

Epidemiology:

Typhoid is very rare in the UK, with around 500 cases occurring each year. In most cases, the infection was caught whilst visiting high risk areas such as Bangladesh, India or Pakistan.

Pathophysiology

• typhoid is transmitted via the faecal-oral route (also in contaminated food and water)
• 10-14 days incubation
• symptoms for 2-4 weeks

PC

• initially systemic upset - headache, fever, arthralgia
• abdominal pain, distension
• constipation: although Salmonella is a recognised cause of diarrhoea, constipation is more common in typhoid
• rose spots: present on the trunk in 40% of patients, and are more common in paratyphoid

On examination

• relative bradycardia

• Disease course: Not commonly seen now due to antibiotics